Provider Demographics
NPI:1790892867
Name:CHEN, PEISHAN (LAC)
Entity Type:Individual
Prefix:MRS
First Name:PEISHAN
Middle Name:
Last Name:CHEN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13400 NORTHUP WAY
Mailing Address - Street 2:#28
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005
Mailing Address - Country:US
Mailing Address - Phone:425-644-2056
Mailing Address - Fax:425-641-7081
Practice Address - Street 1:13400 NORTHUP WAY
Practice Address - Street 2:#28
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005
Practice Address - Country:US
Practice Address - Phone:425-644-2056
Practice Address - Fax:425-641-7081
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00000536171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist